Healthcare Reimbursement in Mauritania: Who Reimburses What Depending on Your Situation

The Franco-Mauritanian bilateral agreement of 1965 coordinates invalidity, old age and survivors, work accidents and family benefits. It does not coordinate sickness-maternity: the CLEISS specifies this for expatriation, indicating that family members who stayed in France receive no sickness or maternity benefit because of your work in Mauritania. There is neither totalisation of periods nor cross-cover: status determines the payer.

Four players can step in: the Mauritanian scheme (CNAM for employees, CNASS, the national health solidarity fund, for the non-salaried), the French scheme maintained for a seconded employee, the CFE and international health insurance. The French embassy recalls that the French state does not cover the healthcare costs of French nationals abroad. The notions of reimbursement base and out-of-pocket cost help compare offers. How the care network works is presented on the healthcare system page.

The employee on a local contract is affiliated by their employer to the CNSS and the CNAM. According to the CLEISS, the CNAM reimburses 67% of the price of medicines, 80% of consultations in the private sector and 90% in the public sector, 90% of hospitalisation, and 100% of medical evacuations, haemodialysis and long-term conditions. The spouse and children up to 21 are dependants. Care must be provided by a provider approved by the CNAM. A private top-up opens direct access to private clinics and evacuation abroad. See the glossary entry on local contract.

The seconded employee remains, under conditions set by the agreement, affiliated to the French scheme. The CLEISS indicates that they then keep cover for care received in Mauritania with no additional contribution, send the paid invoices to their affiliation fund with form S 3125c and must send the sick-leave notice within 48 hours. As Mauritanian prices may exceed French rates, a top-up suited to the country is recommended. See seconded or expatriate and the glossary entry on seconded employees.

The self-employed person or digital nomad benefits neither from the CNAM nor from the CNSS for old age, work accidents and family benefits. The CNASS, a voluntary health insurance launched in September 2023, is aimed at the non-salaried as a family of at least six people or in a group, with a 2-month waiting period and a coordinated care pathway. For a self-employed French national, the CFE or international insurance remains the clearest solution; see digital nomad insurance.

The student has no compulsory scheme locally. Before age 30, the CFE offers its youth offer, priced on quotation; international student insurance is the alternative. See student insurance abroad.

The retiree falls neither under the S1 form (valid in the European Union) nor under automatic cover. The CLEISS specifies that the 1965 agreement does not allow reimbursement in Mauritania of care under the French pension: you must join the CFE voluntarily (retirees’ offer, price on quotation, with no medical questionnaire) or take out private insurance. During a temporary stay in France, care is covered if you receive a French basic pension, can show at least 15 years of insurance in France and do not work; a hospital stay of more than one month requires the prior agreement of the CPAM (local health insurance office), and the spouse is not covered. The CNAREFE (the French health insurance office for retirees living outside the EU), attached to the CPAM of Seine-et-Marne, handles these files. See retirement in Mauritania and the guide retiree health insurance abroad.

The spouse and children accompany the holder: they are CNAM dependants if the holder is a local employee, dependants of the French fund if seconded, or covered by a family contract from the CFE or an insurer. Family members who stayed in France fall only under French law. See expat family insurance.

The CFE is a voluntary social protection body. In France, it reimburses according to the principles of the Assurance Maladie (the French national health insurance), with third-party payment in public and private hospitals; abroad, reimbursement applies as a rate or flat amount depending on the country and the type of procedure. When the Mauritanian price exceeds the base used, the difference remains payable by the member: the guide CFE reimbursements details this mechanism.

• Offers: the main offer (over 30), the youth offer (under 30) and the retirees’ offer are all priced on quotation; no health questionnaire is requested.
• Waiting period: immediate cover if enrolment takes place before departure or within 3 months of settling; beyond that, 3 months’ waiting period before age 44 and 6 months beyond age 45.
• Maternity: conception must be after enrolment or after becoming a dependant.
• Assistance: the subsidised category is for low-income households, on a file examined by the consular service; see subsidised category.

On return to France, the CFE asks for no waiting period to resume membership, and a member without activity benefits from free continuation of their rights for the first three months; then universal health protection opens for anyone residing stably and regularly in France or working there. See reducing the waiting period and return-to-France insurance.

International health insurance at the first euro reimburses actual costs within its ceilings, after any deductible, waiting periods and exclusions. It gives access to the private clinics of Nouakchott with direct payment, which matters when access to care depends on a financial guarantee: France Diplomatie warns that without insurance, access may be compromised even in a life-threatening emergency. Compare the annual ceiling, the coverage zone, evacuation and the treatment of pre-existing conditions.

The tourist must take out, before departure, an assistance contract covering medical costs, surgery, hospitalisation and medical repatriation, because the embassy covers no costs. Bank card assistance can complement this arrangement, with ceilings to check. See long-stay travel insurance.

• Consultation: 80% in the private sector and 90% in the public sector for a CNAM member, up to 10,000 MRU per service; French scheme and S 3125c for the seconded employee; country scale for the CFE; actual costs for a first-euro contract.
• Hospitalisation: 90% from the CNAM and 100% for medical evacuation; French scheme for the seconded employee; third-party payment or direct payment depending on the contract.
• Medicines: 67% from the CNAM, with out-of-pocket cost capped at 1,500 MRU per medicine; reimbursement according to the scale for the CFE.
• Dental and optical: the official sources read do not detail these items for the CNAM; the CFE mentions dental care among its benefits without a detailed rate, and optical care mostly falls under international contracts, within ceilings.
• Maternity: allowance of 100% of salary for 14 weeks for an employee affiliated to the CNSS (54 days or 360 hours of work over the last 3 months); conception after enrolment for the CFE; waiting period common in international contracts.

The reimbursement guide and the page expat health insurance give benchmarks for comparison; Expavy helps you weigh these options against your situation.